Amanda Elizabeth Shaw

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN210233 Issued in GA

Practice address

495 Charles Hardy Pkwy
Dallas, GA 30157-5723

Phone

(770) 445-2128

NPI assigned

Feb 4, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581206400000",
    "number": "1104216639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 CHARLES HARDY PKWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301575723",
            "telephone_number": "770-445-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 CHARLES HARDY PKWY",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301575723",
            "telephone_number": "770-445-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-04",
        "last_updated": "2020-02-09",
        "certification_date": "2020-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN210233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Halli E Selman, CSFA
• Breshona Breana Sereal, RBT
• Sheetal Shah, PHARMD
• Shaping Dreams, LLC
• Jimi Sharomi, PHARMD
• Lindsay Sheets, DMD
• Emily Elizabeth Shepherd, M. ED. CCC-SLP
• Gregory Scott Shepherd, D.C.
• Latoya Lashelle Shepherd
• Kelsey Shepperd, RD

• Family Nurse Practitioner in Dallas, GA
• Providers in Dallas, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.